Kochi: Union Health Minister JP Nadda recently stated that India faces no shortage of anti-rabies vaccines or rabies immunoglobulin, noting that the production capacity — 8.17 crore vials of ARV and 1.77 crore vials of RIG annually — far exceeds demand.
Yet for thousands of dog bite victims, life-saving treatment still depends on where they live and whether they return for follow-ups.
Evidence points to persistent gaps in the availability of these critical biologicals across health facilities, which could potentially undermine India’s efforts to eliminate rabies deaths.
A 2025 nationwide assessment, published in The Lancet Regional Health – Southeast Asia, highlighted structural disparity: while ARVs are relatively more available, RIG — critical for treating severe bites — remains scarce, especially in certain parts of the country.
While these challenges are often associated with rural settings, access alone does not solve the problem. Even where vaccines are available, completing treatment remains a hurdle.
A recent study from Bengaluru found that nearly one in five patients with animal bites failed to complete the full course of post-exposure prophylaxis despite initiating treatment. Compliance declined with each successive dose — dropping from universal uptake at the first dose to just over 80 per cent by the fifth, suggesting that the biggest gaps emerge not at entry, but in follow-through. The steepest fall occurs early in the regimen, pointing to how quickly patients begin to disengage after starting care. Patients cited work commitments, forgetting follow-up dates, and the inconvenience of repeated hospital visits as key barriers.
This gap persists despite India’s commitment to the global ‘Zero by 30’ strategy, formalised in 2018 by the World Health Organization, Food and Agriculture Organization, and World Organisation for Animal Health, and operationalised nationally through the National Rabies Control Programme (NRCP). Under this programme, the government provides free access to ARV and RIG at every healthcare centre to ensure prompt and effective management of animal bite cases, alongside training healthcare professionals in animal bite and rabies management.
Yet, the Lancet study found that of the 467 public health facilities surveyed, RIG was available in just 5.9 per cent of primary centres with only 1.8 per cent of urban PHCs having the medication — underscoring a critical last-mile delivery gap. RIG is required for severe (Category III) dog bites, such as deep or multiple wounds, or bites to the face, head, neck, or hands, and in immunocompromised individuals. It is administered with the anti-rabies vaccine to provide immediate passive immunity while the body builds its own response. Without RIG, Category III cases are most likely to turn fatal.
“This is not a marginal gap — it is a near-complete absence at the level where the majority of India’s rural and urban poor first seek care. The clinical consequence is direct. NRCP guidelines mandate that any wound with bleeding should be treated with RIG in addition to ARV. In practice, over half of all animal bite wounds presenting to health facilities are likely to be category III, requiring RIG as part of Post Exposure Prophylaxis,” said Anup R Warrier, Senior Consultant, Infectious Diseases, Aster Medcity, Kochi.
The burden of rabies
Researchers sampled facilities across 60 districts, including primary and community health centres, secondary and tertiary care institutions, and private facilities. While ARV was available in over 90 per cent of secondary and tertiary public facilities, availability was lowest in urban primary health centres and highest in district hospitals and medical colleges.
India bears a disproportionate share of the global rabies burden, recording over 3.7 million dog bite cases in 2024 — that is nearly 10,000 dog bite cases a day. India accounts for roughly 35 per cent of global dog-mediated rabies deaths. The burden falls heavily on rural and low-income populations.
Rabies is almost 100 per cent fatal once symptoms appear, but timely and complete PEP can prevent death. Primary health centres are often the first point of contact — especially in rural areas — making uninterrupted access to rabies biologicals essential for effective treatment.
“Access to rabies immunoglobulin (RIG) in Bihar continues to be hindered by systemic gaps. There is a shortage of doctors at primary health centres, and the procurement of RIG itself remains difficult, often requiring sourcing from major cities such as Patna. At the same time, limited training means PHC staff may not correctly identify wound categories, leading to false reassurance, downstaging of injuries, and increased risk of rabies infection,” said Shimna Azeez, a public health expert from Kerala who works for WHO India in Bihar. “Poor road connectivity and low awareness further push many people to seek care from unqualified practitioners”.
Another public health professional, Ayanava Basu, emphasised that “rabies management needs injectable preparations, which need proper storage and skilled administration techniques (and dose determination) beyond the primary health care scope. Without MBBS doctors at PHCs, it is practically impossible”.
The study also underscored sharp geographic inequities — while RIG remained scarce across most primary facilities, access to anti-rabies vaccines was highest in southern states, with the Northeast trailing far behind.
“The supply chain failure is not a manufacturing problem — India has adequate production capacity. It is a governance, funding-architecture, and accountability problem, amenable to policy solutions if the political will to treat it with the same urgency as polio eradication is mobilised,” said Warrier. “What is non-negotiable is a functional, real-time, facility-level stock monitoring and alert system — currently absent in most states”.
Also read: British Raj determined what kind of dog was acceptable in India—pets vs strays
‘Real but insufficient progress’
Not completing the full course of PEP further weakens outcomes and highlights that this is not just a gap but a cascade — where supply, trained staff, awareness, and follow-up all break down at different stages. For a disease that is almost always fatal once symptoms appear but entirely preventable with timely and complete treatment, these missed doses can add to the burden of rabies. India’s rabies control efforts, experts say, may need to focus as much on public awareness as on expanding access.
“Grounded in the peer-reviewed literature and Government of India programme data, India is making real but insufficient progress, with the 2030 deadline now posing a very serious challenge,” said Warrier.
“NAPRE, the Government of India’s One Health roadmap, developed with six ministerial endorsements, sets targets of 75 per cent dog-vaccination coverage by 2025 and a 75 per cent reduction in human rabies deaths by 2030. Both targets are behind schedule”, he added.
Though India’s large free-roaming dog population and gaps in treatment completion may suggest it is lagging behind the Zero by 30 goal, progress is possible. Goa offers a compelling example: the state has reported no human rabies deaths since 2017 and was declared rabies-free in 2021. This success has been driven by sustained mass dog vaccination, robust surveillance, and timely access to post-exposure prophylaxis.
“Reducing rabies risk requires a comprehensive approach — minimising dog-human interactions through better waste management, scaling up dog vaccination and sterilisation services across all regions, and integrating rabies prevention into routine immunisation programmes, as recommended by the Association of Prevention and Control for Rabies in India (APCRI),” said Basu.
(Edited by Aamaan Alam Khan)